title: Private payers and cancer care: land of opportunity.
abstract: The costs of cancer care are unsustainable in the present US health care system. Private payers have taken a leading role in oncology payment reform. This benefits all payers, including the Center for Medicare and Medicaid Services (CMS). Private payers' ability to set up systems of measurement and quality improvement is a strategy to support pay-for-value contracting. This facilitates workflow changes in oncology office practice as a way to bend the cost trends while enhancing patient care. Oncology practitioners demand speed and flexibility in deploying customized information technology solutions in exchange for new contracting terms. Pathway and guideline support tools have been proven effective in validating the use of evidence-based medicine and in systematizing office operations to reduce avoidable costs. The future of oncology practice should see further enhancement of these capabilities. A common health information exchange pipeline will allow patients, physicians, and other health care providers to share structured information from multiple electronic medical record/electronic health record platforms. By allowing multiple payers, including CMS, to access commonly accepted clinical decision support rules, any payer can create contracts and relationships with oncology practices. In this manner, future changes in payment for oncology services mandated by CMS can be sustained within the infrastructures being built today through payer-provider collaborations.
authors.affiliation: Aetna, Hartford, CT.
authors.forename: Ira
authors.initials: I
authors.lastname: Klein
authors.forename: Michael
authors.initials: M
authors.lastname: Kolodziej
mesh_terms: D019317:Evidence-Based Medicine / Q000191:economics; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D008484:Medicaid / Q000191:economics; D008495:Medical Oncology / Q000191:economics* / Q000379:methods; D006278:Medicare / Q000191:economics; D009369:Neoplasms / Q000191:economics* / Q000628:therapy*; D012052:Reimbursement, Incentive / Q000191:economics; D014481:United States